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Sex differences in the associations of HIV disease characteristics and body composition in antiretroviral-naive persons^1,2,3

¹ From the Baylor College of Medicine and Houston AIDS Research Team (HART), Houston, TX (FV); the Harlem Hospital and Columbia University, New York, NY (SR and WES); the School of Public Health, University of Minnesota, Minneapolis, MN (CMM and GB); the Body Composition Unit of St. Luke’s–Roosevelt Hospital, Columbia University, New York, NY (JW and DK); the George Washington University and Veterans Affairs Medical Center, Washington, DC (CLG); the Denver Community Programs for Clinical Research on AIDS, Denver, CO (JS); the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, CA (CG); and St Vincent’s Hospital, Sydney, Australia (AC)

Background: Data on associations of body composition with HIV disease characteristics are limited.

Objective: We compared sex-specific associations between HIV disease characteristics and body composition in an racially-ethnically diverse cohort of antiretroviral-naive patients.

Design: The study was a cross-sectional analysis of participants enrolled in a metabolic substudy of a multicenter trial. Regional fat was measured, and total body fat (TBF) was derived by using the Durnin-Womersley formula (DWF) and bioelectrical impedance analysis (BIA). Body cell mass (BCM) was measured by BIA.

Results: Among 422 participants, 22% were women, 60% were African American, and 36% had prior AIDS-defining illnesses. Mean (±SD) age was 38.2 ± 9.6 y, CD4⁺ count was 215 ± 184 cells/mm³, and HIV RNA log₁₀ was 5.0 ± 0.8 copies/mL. On multivariate analysis, women with AIDS-defining illness had significantly (P < 0.005) lower regional body fat and TBF (BIA: –9.5 kg; DWF: –7.3 kg) but nonsignificantly lower BCM (–1.3 kg) than did women without such illnesses, whereas men with AIDS-defining illness had significantly (P < 0.005) lower BCM (–1.7 kg) but nonsignificantly lower TBF (BIA: –1.3 kg; DWF: –1.83 kg) than did men without such illnesses (P < 0.05 for sex differences in TBF). Significant negative associations of HIV RNA with BCM (–0.9 kg/log RNA; P = 0.03), TBF by BIA (–1.4 kg/log RNA; P = 0.05) and by DWF (–1.6 kg/log RNA; P = 0.01), and regional fat were observed in men only.

Conclusions: The effect of prior AIDS illness on body fat differed significantly between the sexes: women with prior AIDS-defining illness had significantly less fat than did women without such illnesses. An independent effect of HIV viremia on BCM and fat was seen in men. These distinctions may be due to inherent biological differences between the sexes.

Key Words: HIV infection • antiretroviral-naive patients • sex differences • body composition • anthropometric analysis • bioelectrical impedance

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